Easing our transition into a post-peak healthcare system

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This blog is going to “go dark” (go offline) for the next few months, possibly permanently.I am sorry if this is a disappointment to those of you who follow it regularly, and I am flattered that so many of you have signed up to follow it and seem to think I have something useful or entertaining to say.I don’t want you to think that I have been arrested, or hospitalised with severe depression, or changed my mind and become an economist, so here is the reason.

There seem to be many events occurring which are pointing towards some sort of global crisis in the near to medium term: Brexit, Trumpism, the rise of nationalism and religious fanaticism around the globe, continuing global economic instability, continuing political instability in the Middle East, imminent peak oil in Saudia Arabia, the imminent collapse of the US shale oil fracking industry, and so on… I feel a bit like many people probably felt in 1860, or 1913, or 1938: there is something big and bad just around the corner, even if it’s not clear exactly what and when.Or in the words of Obi-Wan Kenobi in Star Wars, I sense “a great disturbance in the Force”.

I would like to do something useful in response to this.One (arguably) useful thing I have done is relocate myself and my family to a large rock in the middle of the Irish Sea.OK, I know some of you are not on board with that one, but let’s move on.The other thing I would like to do to benefit my fellow citizens is complete a project which I started in 2010, which is my book on Post Peak Medicine.You can download it here:

It is still very much a work in progress.I would especially like to finish the section on evidence based herbal medicine.This is intended to be a bridge between traditional and orthodox medicine, or herbal medicine rewritten in a form which conventionally trained physicians can understand and have confidence in.Too many herbal medicine textbooks state “Plant X is reputed by (insert name of indigenous people) to be a cure for diseases A, B, C, D and E” but no evidence other than “traditional knowledge” is put forward to support these statements.I would like to research the controlled trials which have been done and try to sort out the herbal medicines which have a genuine physical effect from the ones which have only placebo effect.This is going to be a marathon task as there are hundreds of herbal medicines to sort through, it is going to take a lot of time, and I’ve decided I don’t have the time to do that and also keep writing a monthly blog.

Here are a couple of examples of why this is useful.Take a look at this article on making your own colloidal silver, beloved of survivalists:

It’s reputed to have antibacterial properties.The trouble is, controlled clinical trials show it doesn’t work.So you can save yourself the time and trouble of making colloidal silver, and use your silver for something more useful like bartering for food.

On the other hand, the herb Valerian has been shown in controlled clinical trials to be an effective hypnotic and sedative.And that’s what we’re going to need going forward into the Long Emergency: not cholesterol lowering drugs, or antihypertensives, or appetite suppressants, but lots and lots of sedatives.

“Evidence based herbal medicine” started life as a chapter in the Post Peak Medicine book, but it now looks as though it is such a large subject that it needs a separate book in its own right.Therefore, if you visit the Post Peak Medicine downloads page (see above), you will now find two download links, although the second one is currently empty.

Splitting the book into two has the additional advantage that I can show “Evidence based herbal medicine” to more people than “Post Peak Medicine”.Herbal medicine is an acceptable topic for mainstream discourse, even if it is still viewed as a bit eccentric.Discussions about the end of economic growth, or peak energy, or the collapse of industrial civilisation, are definitely not acceptable in mainstream society (yet), and I would guess, probably won’t be until the facts are so obvious that it’s impossible to continue to ignore them.

If you want to know about the progress of the book you can download the latest version from the website or email me at PeakDoc(at) postpeakmedicine.com.And with that, I’m signing off.Have a Merry Christmas, a sedated New Year, good luck, and as always:

Sitting here atop a large rock in the middle of the Irish Sea, I have a similar feeling about the US election that the local Spanish fishermen probably felt in 1805 as they witnessed the Battle of Trafalgar taking place off their shore. They would have marvelled at the sound and fury of the British, French and Spanish navies duking it out, they might have had a vague feeling that they were witnessing some historically momentous event, the significance of which they didn’t fully understand, and they would probably have guessed that regardless of who won, it wouldn’t benefit them. Which it didn’t: the British won but Napoleon still invaded Spain. I didn’t get to vote in the recent US election (not being a US citizen), but as half the talking heads on the planet are now analysing the election result, I’m going to throw in my tuppence worth.

There are many similarities between Trump’s election victory and the recent vote for Brexit. In both cases, the ruling political and economic elites wanted a continuation of the status quo, the ordinary people wanted anything but that, and the will of the people prevailed over that of the elites. In both cases nobody is sure what happens next.

Immigration seems to have been a major factor in both results. The ruling political and economic elites want more immigration, because more immigrants means low wages which means cheap stuff which means higher profits which means higher share prices. The ordinary people, who mostly don’t have shares, stock options and profit related bonuses, can see that more immigrants means fewer jobs and lower wages for them, and that it has a distorting effect on local communities. You can easily assimilate a handful of Syrian, Mexican or Polish families. However, when hundreds or thousands of such families move in, this changes the nature of communities as mosques replace churches, halal supermarkets replace butchers’ shops, and Polish instead of English becomes the dominant language in the community centre. This isn’t what people want and it’s not what they signed up for when they moved into the community. Also, despite humanitarian concerns about people from war zones seeking asylum, it’s not physically possible to relocate all refugees from all war zones from the Middle East and North Africa into the West – the scale of the problem is just too big.

People have compared Trump to Hitler. It’s true that both men came to power on a wave of popular sentiment fuelled by adverse economic circumstances, but there the similarity ends. Hitler was a brilliant orator and he had a plan, even if it was an insane, perverted plan. Trump can’t seem to open his mouth without putting his foot in it, and I haven’t been able to discern any coherent plan so far. So I’d like to offer you my own historical comparisons.

Clinton I would compare to Henry the 7th of England. You know what you’re going to get: a member of the hereditary ruling aristocracy who is going to continue broadly similar policies to those of Henry the 1st though to 6th. That’s why the majority of people didn’t vote for her.

Trump is more difficult to place. I would liken him to a second-rank player who is swept to power on a wave of popular emotion, or who finds himself in the right place at the right time, but who doesn’t have the talent or intellectual capability to consolidate his grip on power in his own right. I would liken him to Mussolini (shot by communist partisans in 1945), Robespierre (guillotined on the order of the French National Convention in 1794) or the teenage Roman emperor Romulus Augustulus (appointed by his father and deposed at the age of 16 by the Roman general Odoacer just before the collapse of the Western Roman Empire). I wish Mr Trump well with his endeavours, I really do, but I have a deep foreboding about it, because as you can see from the historical examples I have cited, second rank political leaders in times of great change often come to a bad end.

I think the best outcome for this election would be if Trump can quickly assemble a group of competent, trusted advisors who can craft a coherent set of policies for him on immigration, foreign policy, the economy and women’s rights, out of the mess of incoherent speeches which he has made over the last few months. He could then act as a figurehead while the policies are implemented in the background by people who are more politically experienced than he is. If this is done I think he is more likely to bring about “hope and change” than Obama ever was. If this isn’t done, I have a bad feeling about where this whole thing is going.

Today I’m going to talk about overshoot. Other people have written about this far more eloquently than I can – for example, Albert Bartlett and William Catton practically made it their life’s work to educate people about overshoot – but there’s no harm in revisiting it from a slightly different perspective. I’m going to set the scene by briefly reviewing the last 11,000 years of human history. Don’t worry, I know you’re all busy people so I’m going to give you the condensed version which shouldn’t take more than five minutes.

We’ll begin at the end of the last ice age, or more correctly, glacial period. This ended about 11,000 years ago, giving rise to the current Holocene interglacial period. The great ice sheets which covered most of Northern Europe and North America retreated and the climate became warmer and more stable. These conditions enabled humans to spread rapidly across the planet and to transition from nomadic hunter-gatherer bands to settled agricultural societies and complex civilizations.

Humans are very adaptable animals and soon filled almost every available ecological niche. To illustrate this let’s fast forward to the Battle of Jericho, which is said to have taken place around 1400 BC, or 7,600 years after the ice sheets retreated. The story of Jericho is told in the Book of Joshua in the Hebrew Bible. It says that the children of Israel were slaves in Egypt, but were led out of Egypt by the prophet Moses, and after many years wandering in the desert, came to the promised land of Canaan. Moses instructed them to seize the land by conquest and placed them under the command of Joshua. Jericho was the first city of Canaan to be taken. Following God’s law of “herem” the Israelites took no slaves or plunder but slaughtered every man, woman and child in Jericho, sparing only a single Canaanite prostitute.

Most historians think that the story of Jericho is a myth, that neither the exodus from Egypt nor the battle of Jericho ever happened, and that the story was written for the purpose of nationalist propaganda or to illustrate a theological point. However, whether this particular story is historically accurate or not is largely immaterial, because the migration and subsequent conflict which it describes were probably typical of many which occurred in the Biblical era. The main points which I want you to take away from this are that (according to the story) both Egypt and Canaan were already fully occupied. The maximum carrying capacity of the land had been reached and there was no room for any more people. The only way for the Israelites to establish themselves was to displace people who had already settled in the region. As they did not have the numbers or the military muscle to displace the Egyptians, they displaced the weaker and less numerous Canaanites, and as there was no room for the displaced Canaanites, they had to be disposed of. Nothing personal; just business.

Now let’s fast forward again to 476 AD and the fall of the Western Roman Empire. The reasons for the fall are many and complex, but the main issue seems to have been an expansion in the numbers of barbarian tribes in north-eastern Europe and central Asia such as the Huns, who swept southwest across Europe, displacing other tribes such as the Goths and Vandals into the Roman Empire, who in turn displaced the Romans eastwards towards their new base at Constantinople, abandoning Rome to its fate. Again we see the same dynamic at work: the land was occupied up to its maximum carrying capacity, there was no room for any more people, and any expansion had to be at the expense of someone else.

Fast forward once more to 1492 and Columbus’ discovery of the vast empty lands of the Americas, ripe for colonisation. The problem with this story is that it’s a Western myth. The Americas had already been discovered and every available niche was occupied by indigenous people: there was no room for anyone else. The vast empty plains of the North American Midwest discovered by the European settlers (“Oh give me a home where the buffalo roam” etc) were an illusion: every square mile of grassland was already claimed, occupied, hunted or cultivated by indigenous people. The only way the Western colonists could free up the land for their own use was by displacing the existing inhabitants by disease, war, coercion or trickery.

The point I’m making in this brief guided tour of human history is that very soon after the end of the last glacial period the planet was fully occupied by humans. What do we mean by “fully occupied”? This means that the number of humans expanded until it met or exceeded the carrying capacity of the environment. Carrying capacity varies greatly depending on the nature of the land. For example, in the frozen Canadian Arctic or in the Australian desert outback there may only be a handful of people per thousand square miles, but if this is all the land can support, then this is the carrying capacity and it’s fully occupied. In contrast, the warm and fertile farmlands of southern England can support dozens of people per square mile.

This land is fully occupied…

…and so is this.

There are a few tricks we humans can deploy to temporarily increase the carrying capacity and accommodate greater numbers. One way is to transition from a nomadic hunter-gatherer way of life to a settled agricultural way of life. This was first tried in the “fertile crescent” area of the Middle East, otherwise known as the “cradle of civilization”. Much more food can be produced by farming than by hunting, but often this is only temporary and crop yields fall as longer term complications occur, for example, depletion of minerals in the soil, or salination from prolonged irrigation. The Middle East is much less fertile now than it was 6,000 years ago.

Local carrying capacity can be increased by importing food from elsewhere; for example, ancient Rome imported large quantities of grain from Egypt, and today’s Middle East countries import food, technology and expertise into into their barren, mostly desert land, paying for them with oil revenues. This is a zero-sum game because any increase in the carrying capacity of the importing area is offset by a decrease in the carrying capacity of the exporting area. This is the problem when, for example, farmland in Africa is appropriated for growing cash crops for export.

Finally, the environment can be “mined” for resources in an unsustainable way, resulting in a population boom followed by a bust. Easter Island is one example of this – and also most of today’s “advanced” civilizations. Most of our food is made from and/or transported by oil, and farmlands are irrigated by water from deep aquifers which are being drained faster than they can be replenished. It’s logical to expect that as the availability of oil and water decline, so will the availability of food and the size of the population.

We can put some figures on this. Wikipedia’s World Population Estimates suggest that at the beginning of the Holocene interglacial period there were about 5 million humans worldwide. As the ice sheets retreated, the land warmed and the practice of agriculture spread, human numbers increased to around 300 million and stayed fairly constant at that level until around 900 AD. From 900 to 1800 AD the population slowly but steadily increased by about 100 million each century, reaching 900 million at the start of the Industrial Revolution. Since the start of the Industrial Revolution the population has exploded to over 7 billion – that’s an average increase of around 1 billion people every 30 years, far exceeding any known historical population growth rates. This has been made possible by the mining of non-renewable resources – fossil fuels, water, topsoil, minerals – and to a lesser extent, expropriating land from hunter gatherers worldwide and converting it to industrialised agriculture.

So where do we go from here? As Steincke said, it’s difficult to make predictions, especially about the future, but here is my best shot. I’ll look first at what seems to be the most likely global result, followed by zooming in on some of the finer detail.

The sustainable carrying capacity of the planet is probably around 1 billion people, similar to the pre-industrial population. There is a lot of happy talk from politicians and environmental and human rights organisations who say that population isn’t the problem, and that if we only had a more equal distribution of resources we could support even more people than we have today. I don’t buy into that because it sounds like wishful thinking. Distribution of resources never has been fair and probably never will be. A more likely outcome is that as resources become scarcer, the human population will shrink back towards 1 billion, and we will lose some 6 billion people along the way.

I think that only a minority of those deaths will be from starvation (but see below). The majority of deaths will be due to conflict: either directly from injuries sustained as a result of the fighting, or indirectly due to the mass migration of populations out of war zones. The events following the collapse of the Soviet Union also suggest that many deaths will be caused by psychological trauma; for example, alcoholism and suicide.

Conflict of all kinds will spread and intensify. As oil and food supplies dry up in the Middle East, there will be mass migrations of people out of the area. However, few countries will be willing or able to receive large numbers of refugees. This will set up conflicts between the incoming refugees and the populations of the receiving countries, and also internal conflicts between factions within the receiving countries who want to either accept the refugees, or keep them out. (Does any of this sound familiar – think Brexit?).

North America will experience an action replay of 476 AD, but with the migrations being from south to north instead of north-east to south-west. As the climate warms and the aquifers dry up, people will try to migrate from the hotter, drier regions to the cooler, wetter regions to try to achieve better economic and food security. Mexicans will migrate north across the border displacing people from the southern US, people from the southern US will try to move into the northern US, and there will be increased pressure on Canada to accept American migrants. (Again, does anything sound familiar, especially to people living near the Mexico-US border?).

Countries in possession of valuable resources will find that this is both a blessing and a curse. A blessing, because selling them to the highest bidder may bring great wealth (if wealth is worth anything), and a curse because they may attract floods of refugees and possibly invading armies. I am thinking particularly of Canada’s farmlands, forests, tar sands and fresh water and whether the US is going to want a piece of that action. The US has already invaded Canada twice: in the American Revolutionary War in 1775 and the War of 1812. What goes around, comes around.

I have a bad feeling about the Far East, and in particular India and China. They each have 1.3 billion people, that’s 2.6 billion people between them, which is one third of the world’s population. With so many people, if things start to go wrong they could go really wrong really fast, and I can see food shortages there resulting in mass starvation. In China’s Great Famine in 1959-61 there were 36 million deaths due to starvation. India is already one of the highest ranking countries in the world for children suffering from malnutrition.

However, to prove I’m not just a doomsayer, I would like to point out one bright spot on the horizon which is southern Africa, that is to say, that part of Africa south of the Sahara Desert. I think Southern Africa could potentially come out of the Long Emergency, or whatever you like to call it, rather well. For the last 500 years the continent has suffered greatly at the hands of European colonists and entrepreneurs: we have taken their farmland and used it to grow Western cash crops, destroyed their indigenous cultures by sending missionaries, exported millions of them to work as slaves on cotton and tobacco plantations, dug up and carried away their mineral wealth (for example gold, diamonds and cobalt) and lured them into taking out unrepayable loans at high rates of interest. No wonder the place is now a mess. However, if Westerners would just leave it alone, it could come through the traumas of the 21st century relatively unscathed or even improved.

As for me, I’ve made my choice. I and my family have moved to the Isle of Man, a tiny island in the middle of the Irish Sea, human population 88,000, sheep population around 15,000. We have a fairly good idea where our next meal might be coming from, we are unlikely to get many refugees, and we don’t have any oil, gold or diamonds for invading armies to dig up or fight over. But in case you are thinking of coming here, I have some bad news for you: we’re full. No room for any more people.

As you may know if you’ve been following this blog, I recently moved to the Isle of Man and started work here with the intention of staying long term. My family and I made the move for a number of reasons which I won’t bore you with, but let’s say that I have given considerable thought to the pros and cons of the Isle of Man as a bug-out location. “Bug out” is military / survivalist slang for a place of safety to go to in a time of danger or crisis, for example, war, civil disorder, financial crisis or food or energy shortage. Its counterpart, “bugging in”, is preparing for the danger or crisis while remaining in place, so technically I suppose that having bugged out, I am now preparing to bug in.

While you are reading this article, I want you to think carefully about how it compares with your own situation, and in particular, whether you think that you will be safe and / or happy staying in your current location for the next 20-30 years. If so, that’s great, you should continue forming and strengthening your community relationships, growing and storing food, installing solar panels, getting yourself in good physical shape and so on. If not, I would strongly urge you to start preparing to move somewhere else now. Please don’t leave it too late. It was relatively easy for me to move to the Isle of Man because there is only one of me, I only need one house and one job, and I could take my time over it and plan the move carefully. But if a crisis occurs and you find yourself competing with 100,000 other people for that one house and one job in the place you want to go to, it’s going to be a different story. We are in a period of relative calm right now, there are (more or less) adequate supplies of oil, food, water, jobs and houses, but we don’t know how long the present state of affairs is going to last.

“Too late” may come sooner than you think, and for some people, like the Iraquis and Syrians, “too late” has already arrived. Buying a house in Aleppo, Syria probably seemed like a sensible decision in 2010 because the property market was rising, there were lots of jobs, good schools for the kids, plenty of leisure and cultural activities, a strong and stable government, right? With the place now overrun by religious maniacs with Kalashnikovs, it doesn’t look like such a good decision with hindsight. Try to look at, not what a place is like now, but what it might be like in 20-30 years time and what might go wrong in the meantime. Follow the good advice of John Michael Greer and “collapse now and avoid the rush”.

Try to ensure that your home doesn’t become a “stranded asset” which Wikipedia defines as “an asset which has suffered from unanticipated or premature write-down”. This was a significant reason why I thought selling our home in rural Canada at this time and moving to the Isle of Man would be a wise move. Here’s the problem: a lot of people have invested a lot of money in their homes. They represent a large chunk of our net worth – but only so long as it’s possible to sell them to someone who is willing to buy them. Suppose you have a nice home in a rural area but there’s no public transport, it’s about 40 miles to your place of work and it takes you about an hour to drive there every day. Now suppose that the cost of transportation fuel rises significantly, or the Government introduces restrictions on the amount of fuel you can buy each week, or maybe the local gas station sometimes runs out of fuel altogether. That 1-hour drive becomes an 8-hour walk.

You start thinking that maybe you should buy an electric car. Strangely, everyone else has had the same idea at the same time, as a result of which the price has gone way up, there are long waiting lists for new ones, and ominous reports in the mainstream news about a worldwide shortage of lithium to manufacture the batteries. You start thinking that maybe you should relocate. However, at that point, nobody wants to buy your home for the same reason that you want to sell it: it is literally and metaphorically a stranded asset because you can’t get there in the absence of transportation fuel. At that point you have left it too late and your choices have narrowed down to either staying put, or walking away from it. What you should have done was to sell it before the crisis occurred, and while there were still people willing to buy it.

(Footnote: we bought an electric car earlier this year. More about the practicalities of these unusual vehicles in a future post).

So back to the Isle of Man. I am going to say some quite negative things about the Isle of Man, and after reading a few paragraphs of this you might be forgiven for thinking “if he hates the Isle of Man so much why doesn’t he go back to Canada?” But that’s not it at all. I have loved the Isle of Man since childhood, I think it has good long term prospects and I am simply being realistic. There is no such thing as the perfect bug-out or bug-in location, all of them have drawbacks and compromises, and I am going to list both the bad and the good things. If you have been following John Michael Greer’s blog posts in “The Archdruid Report” about the fictional post-collapse country of “Retrotopia” – well, the Isle of Man is a bit like that.

Let’s start with the basics. The Isle of Man is a large rock in the middle of the Irish Sea about halfway between England and Ireland. It is 32 miles long, 14 miles wide and its highest point, Snaefell mountain, rises to 2034 feet above sea level. It has a population of 85,000 of which about 37,000 live in the capital, Douglas, and the remainder live in smaller towns and villages scattered throughout the island. The islanders used to speak the Manx language, which is a form of Gaelic. Speaking the language has virtually died out, but the laws, place names on road signs and Government documents are usually written in both Manx and English. The symbol of the Isle of Man is three legs joined at the hip (a triskelion, an ancient Greek and Celtic symbol) and the motto is “Quocunque jeceris stabit” which is Latin for “Wherever you throw it, it will stand”.

The Isle of Man triskelion. Wherever you throw it, it will stand.

Prior to Victorian times, the main economic activities were farming and fishing, particularly for herring, which were then smoked and turned into “kippers”, an island delicacy. There was also some mining of lead, silver, zinc and copper. Probably due to mismanagement of the fish stocks, the herring fishery around the island has practically died out. Kippers are still produced here, but the herring are mostly imported from Norway. All the mines closed long ago but they are still a tourist attraction.

In Victorian times, there was a great boom in the tourist industry, with tens of thousands of factory workers from Lancashire and Merseyside coming over on the boats for their annual holidays. A great deal of Victorian infrastructure was built, much of which is still operating today, such as steam and electric railways, horse trams, a water powered roundabout for children, a giant water wheel to pump water out of the mines, and hundreds of guest houses and hotels. People come here for “steampunk” themed weddings. However, the Isle of Man tourist industry declined in the 1970s with the advent of cheap air travel to warmer places.

Motorcycle racing is an important activity on the island, not on racetracks but on the public roads around the island, which are closed to normal traffic while the races took place. The races take place several times per year, the most famous (and dangerous) being the TT (“Tourist Trophy”) races every May / June.

The island operates in the shadow of the UK but is not technically UK territory, being instead a “Crown dependency”. Don’t worry if you don’t get the subtle distinction between these two: 99% of British people don’t get it either. What it means in practice is that the island has its own government and makes its own laws, which are usually very similar to UK laws but don’t necessarily have to be. In particular, the island was never part of the European Union and is therefore less affected by Brexit than the UK, although it will probably have some impact at some point. (Dang, I wasn’t going to mention Brexit again but I did – sorry about that.) The other big difference is that the island has significantly lower tax rates than most other places – a maximum 20% tax on income and no capital gains or inheritance tax. This in turn has led it to develop a large offshore financial services industry and online gambling industry which today make up a large part of the island’s economy. Officially, the island denies that it is a tax haven, but in reality that’s what it is.

If civilization as we know it collapses, I don’t think there will be much demand for tourism, motorcycle racing, offshore banking or online gambling. Unfortunately, as I have already mentioned, these activities make up most of the Isle of Man economy. As if that wasn’t bad enough, the island has been running a significant budget deficit for several years, spending about 20% more than it earns each year. (Greece, anyone? Or perhaps Iceland?). This is largely hidden from public view by smoke-and-mirrors accounting techniques, but basically the annual deficits have been funded from reserves, which are finite and rapidly depleting. This enables the Manx politicians to claim “we can balance the budget without borrowing”, even though it isn’t really true. Taking all of these factors into account, the wheels are likely to come off the Manx economy in a big way in about five years from now.

Manx politicians are mostly independents, with no affiliation to any political party. This is a good thing as it avoids much of the groupthink and cronyism which infects political parties. However, Manx politicians are just as deluded as politicians anywhere else when it comes to the economy, and talk incessantly about “growth” being the answer to all the island’s economic problems, or worse still, “sustainable growth”. There is no such thing as “sustainable growth”; if a thing is growing, it is not sustainable, and vice versa. There is no talk about how much growth we need, or what the goal or end-point should be, so I presume they are talking about infinite, perpetual growth. Which is strange, because if you stand on Snaefell summit you can see the entire island, and it is obviously a finite size and cannot support infinite growth.

The Manx electorate are little better. They don’t question their politicians about the infinite growth or the suspect finances, and probably they don’t really want to know. They tend to elect Manx-born politicians, regardless of their suitability for the job. Most of them would be happy to scrap the horse drawn trams and other elements of Victorian infrastructure because they slow down the road traffic.

Most of the Isle of Man’s energy, in particular gasoline, diesel, home heating oil and electricity, is imported from the mainland. A small amount of electricity is generated locally in a small waste-to-energy plant, gas turbine generator and hydroelectric generator, but these are a drop in the bucket. There is a lot of wind energy on the island which could be harnessed – after all, we are in the middle of the Irish Sea – but there is no appetite among the local population for building wind farms as this would spoil the view, and as far as I know there is not a single wind turbine on the island or offshore. So in the event of an interruption in the energy supplies from the mainland, most activity on the island would rapidly grind to a halt.

So those were a few negatives. Now for the positives. The Manx are a proud, independent and resourceful people, as implied by their motto “Wherever you throw it, it will stand.” There is also a strong community spirit. I therefore like to think that if there is a crisis, they will pull together and find a way through it, and I think it is very unlikely they will resort to looting shops or inflicting violence on each other.

The island’s isolation is an advantage. When the Romans occupied Britain they took one look at the rock on the horizon, thought “Fugeddaboudit” and didn’t bother coming here. I hope other would-be invaders will take the same view. The same goes for refugees – about which I will say more in my next post. The coming crises of the 21st century will probably generate hundreds of millions of economic, environmental and conflict refugees who will criss-cross the world in all directions looking for a safe haven. The current war and refugee crisis in Syria is only a foretaste of things to come. Only the most determined and resourceful will make it to the Isle of Man, because the Irish Sea is a tricky stretch of water to cross at the best of times, even with a good boat, and once here it’s impossible to remain inconspicuous.

The Isle of Man has no natural resources which can be dug or drilled up and carried away. We are therefore unlikely to suffer the “resource curse” experienced by other countries which are rich in gold, silver, oil or diamonds. The presence of resources like these has made life miserable for many generations of indigenous poor people in Africa, South America and the Middle East, as powerful invaders fight over them. We have a lot of sheep here, but if you are an invading army backed by an arsenal of missiles, drones and nuclear weapons, you are probably looking for more than sheep. For an example of what a resource curse looks like, check out this article about a proposed fracking well near a village in North Yorkshire, UK.

It rains a lot here – the mountains attract rain-bearing clouds – so we are unlikely to ever have to worry about supplies of fresh water. Nor do we have to worry too much about sea level rise, as we can just move a few feet further inland and further up the slopes of the mountains.

Houses at Onchan Head, Douglas. If sea level rises more than 100 feet, these people will be in serious trouble.

In a crisis, the Victorian steam-powered and water-powered infrastructure could once again be put to good use – provided the islanders haven’t stupidly got rid of it and thrown out the baby with the bathwater.

Like many other places, the Isle of Man has overshot its carrying capacity due to population growth, and there are more people currently living here than can be supported by local food and energy resources. This is a cause for concern, but I believe it could be addressed if the Manx people and their politicians had the will to do it. If there was an economic downturn such that the offshore banking and online gambling sectors were no longer viable, most of the people involved in those industries would probably leave the island, reducing the total population. I don’t think that would be any great loss, because the main activity of both industries seems to be moving digital money from one computer folder to another, which doesn’t seem to me to be a particularly useful or productive activity. If the herring are fished less intensively, the stocks will recover. If the islanders can get their heads around the necessity of generating their energy locally, wind farms could be developed to generate electricity, and more land could be turned over to managed forestry plantations to produce wood for home heating. All of those things are possible, but to make a smooth transition into a renewable food and energy future, we should be doing them now, or better still, we should have started them 20 years ago.

I would be interested in hearing from readers how you view your current situation and whether you are planning to move or stay put. In 20 years from now, do you think you will have more in common with a Syrian or a Manx?

“You must be the Government Locum” said the receptionist, eyeing me suspiciously. It came as a bit of a shock, because for most of my life I’ve had a healthy mistrust of governments of all political flavours, and I didn’t consider that I would ever be one (or a small part of one). However, looking at myself in the mirror, with my business suit and my official Government laptop with my official Government email account, I had to admit that she was right: I must be the Government Locum.

Memories of my former private medical practice in Ontario, Canada are rapidly fading. My new job is go round all the GP practices (or “surgeries” as they are known here) in the Isle of Man – there are 12 altogether – covering for family doctors who are off sick, on maternity leave or doing continuing professional development. For that, I get paid a salary by the Isle of Man Government. It’s a great job, you get to meet the entire medical community on the island very quickly, but you see some weird stuff. It’s like a keyhole into the secret lives of doctors.

For example, in one surgery there was a pile of medical journals about two feet high on a chair, still in their plastic wrappers, never read. I wonder how up to date that doctor was. In another, there was a blood pressure monitor (sphygmomanometer) which didn’t appear to work. On closer inspection, it was missing its power supply. After a thorough search of the office I found the power supply at the back of a cupboard – it looked as though it hadn’t been used for years. I plugged it in and it worked perfectly. I wonder how that doctor took patients’ blood pressures? And in yet another office, I found a half eaten plate of food in the desk drawer. The doctor had obviously not finished his / her lunch, called the first patient in, hastily hidden the plate in the drawer intending to retrieve it later, and forgotten about it. Yuk.

One lunchtime I decided to go onto Douglas high street and buy myself a kipper sandwich. It was years since I had kippers (smoked herring) which are a Manx specialty. As I left the shop, sandwich in hand, the shopkeeper called after me “Watch out for the seagulls!” With a cheery wave and a wry smile at the Manx sense of humour, I headed to the promenade to enjoy the sea breeze and the views over Douglas Bay towards Onchan Head. Suddenly, someone (as I thought) crept up behind me, whacked me over the head with what felt like a bag of groceries and tried to snatch the kipper sandwich out of my hand. When I had recovered my balance, I looked around to see who my assailant was. There was nobody there. I looked up. There was a seagull the size of a vulture circling three feet above me and preparing to come in for a second attack. I hurried back to the safety of the high street. So much for the Manx sense of humour.

As I’m going to be here for a while – quite possibly permanently – I thought it would be a good idea to try to blend in with the locals. When the time comes for the Manx people to decide who gets to stay on the island and who gets kicked off (more about this in my next post) I don’t want to end up with a terrible fate like that off-island policeman in the 1973 movie “The Wicker Man”. So every Friday night I take my melodeon (button accordion to North American readers) down the local pub and join in the Manx music sessions. They play tunes with catchy titles like “Tra va mee aeg ayns Rumsaa”. F*** knows how you’re supposed to pronounce that, but I can play it. If anyone else is interested in having a go at this you can find the dots to this and other Manx session tunes here:

You may be wondering what has happened about Brexit? The Manx people are going about their normal business as though nothing has happened, which is actually not far from the truth (see my last post). There is no rioting in the streets, people are not throwing themselves off the cliffs, and people are not selling their babies on street corners in order to buy food. Unless something of significance actually happens with Brexit, I shall speak of it no more.

In my next post, I intend to deal at some length with the subject you have (probably) all been waiting for: the pros and cons of the Isle of Man as a bug-out location in the event of economic collapse, peak oil, climate change, nuclear war and other looming man made disasters of the 21st century.

Slaynt vie, bea veayn, beeal fliugh as baase ayns Mannin

Douglas promenade. Watch out for the vulture-size, psychotic killer seagulls

I am writing this post from the Isle of Man, which is a small island off the coast of Britain. I arrived here just over a week ago. Before you start saying “Isle of What?” and reaching for Google maps, that’s not important right now, and I’ll tell you all about it another time. I was planning to write this blog post about why I’m here and what I’m doing in the Isle of Man, but six days after I arrived, the Brexit fiasco erupted so I thought I’d better write about that instead.

Unless you’ve been in a coma for the last week, you’ve probably heard about Brexit, but just in case you’re a bit confused about the facts, I’ll try to bring you up to speed.

“Brexit” is short for “Britain’s exit from the European Union” (EU). The back story to this is as follows: Britain joined the European union as a result of a referendum held in 1972. The British Prime Minister David Cameron (shortly to be ex-prime minister, see below) organized a second referendum of the British people to ask whether they wanted to leave, or remain in, the European Union, which was held on 23 June this year. Quite why he thought this referendum would be a good idea is unclear; it seems to have been an attempt to gain some kind of edge over his political rivals. In the weeks leading up to the referendum, there was intense campaigning by both the “Leave” and “Remain” factions, but nobody seriously doubted what the outcome would be: there would be a lot of impassioned speeches and a lot of grumbling, but at the end of the day the British people would vote to maintain the status quo and continue membership of the EU.

Everyone, including the “Leave” faction, was therefore stunned when the result of the referendum was announced the morning after: the British people had voted, by 51.9% to 48.1% to leave the EU. This was not supposed to happen, and consequently, nobody had prepared for it. In the days following the result there was intense political bloodletting, with Cameron resigning as Prime Minister, and a vote of no confidence being called to oust Jeremy Corbyn, the Leader of the Opposition. Right now, it’s not clear who is in charge of anything or what is supposed to happen next. The problem is, anyone who campaigned strongly to “Remain” (like Cameron) would be unacceptable to half of the electorate, anyone who campaigned strongly to “Leave” (like Nigel Farage, leader of the UK Independence Party) would be unacceptable to the other half of the electorate, and anyone who sat on the fence and didn’t declare strongly for either side (like Corbyn) would be unacceptable to everyone.

The “Remain” campaign focused mainly on the economic benefits of staying in the EU. The “Leave” campaign focused mainly on immigration. In the end, concerns about immigration trumped concerns about the economy. There have been attempts to portray the immigration issue as “racist”, but that would be to either misunderstand or misrepresent what the campaign was about. It was not about racism, but about sovereignty. Membership of the EU is based on free movement of people, goods and services, and the EU Commissioners have pursued these goals with an obsessional, almost puritanical zeal, allowing no compromise. You have to allow total, unrestricted immigration or you can’t be a member of the club. The problem is that this conflicts with the basic right of a sovereign country to exercise control over who enters, and who remains in, the country

Despite the global hysteria I find it difficult to get excited about Brexit for two reasons. Firstly, the countries of Europe have been dancing a complicated dance with each other for over two thousand years. In turn, they are sometimes the underdog, sometimes dominant, sometimes at war with each other, sometimes at peace, sometimes they trade with each other, sometimes they put up trade barriers and embargoes. Sometimes the ruling class of one country will impose itself by force on the ruling class of another, sometimes they will forge alliances by intermarrying. This is particularly true of the Big Six countries: Greece, Italy, France, Germany, Spain, England. All of them except Germany have at one time controlled a world class empire (Germany had a stab at this in the 20th century but didn’t get very far) and all of them have at one time been a collection of primitive tribes under the control of a more powerful neighbour. Britain joining the EU and then leaving it again are the latest iterations of this dance which is likely to continue for many centuries after the EU is disbanded.

Analysis of the referendum results suggested that older people were more likely to vote “leave” whereas younger people were more likely to vote “remain”. I suspect that is because to get a grip on this thing, you need to have a historical perspective on it, and older people are more likely to have that perspective. As a card carrying wrinkly (I’m 56) that probably explains where I’m coming from.

The other reason I can’t get too excited about it is because the whole question of EU membership could well become irrelevant in the near future. The free movement of people, goods and services presupposes that we have the physical capability to do this. Most of this movement is made possible by fossil fuels. Two little words which were not heard at all during the campaigning were “peak oil”. If the world is currently at or just past peak conventional oil, then this unrestricted free movement may only be possible in its current form for another couple of decades, after which it will be a moot point.

My predictions for what happens next: I think there will be continuing political and economic instability for several years until a new equilibrium is found. It’s difficult to be sure what that will look like, but it will probably be something like the pre-1972 situation. I would also guess that the next crisis to hit the EU may be “Grexit”, or “Greek exit”. The Greeks are probably assessing the situation right now and wondering whether they would be better off defaulting on their mountain of unrepayable Euro debt, leaving the EU and forming a closer alliance with other non-EU countries like the UK, North America and Australia.

“He who sups with the Devil should have a long spoon”. English proverbial saying, 14th century.

In our medical office, Thursday is drug lunch day, when a pharmaceutical company rep buys the whole office lunch and in return, gets the undivided attention of the physicians for one hour to promote whatever the product du jour happens to be. In biological terms it’s a bit like a host-parasite relationship where the pharmaceutical company is the host, the physicians are the parasites, and the reception and nursing staff are the commensals (they get to eat the food but don’t have to stay for the talk).

Today was a bit different because the drug rep was accompanied by Dr X (not his real name), a professional colleague from a nearby town who gave us a talk about the benefits of orlistat (Xenical) and liraglutide (Saxenda) in the treatment of obesity. The drug rep was from Novo Nordisk who, coincidentally, just happen to manufacture Saxenda.

I sat through the talk with a mounting but ill defined sense of unease. Of course, I agreed with Dr X that obesity is a big problem in industrialized societies (in the US, 35% of the adult population is obese). Naturally, I agreed with him that it is associated with many medical conditions including heart disease and stroke, high blood pressure, diabetes, cancer, gallbladder disease and gallstones, osteoarthritis, gout, sleep apnea and asthma. And it goes without saying that I agreed with him that Xenical and Saxenda could produce (in the short term anyway) a reduction in obesity and the associated medical conditions. So prescribing Xenical and Saxenda seemed like a no-brainer.

And yet…something still troubled me which I found it difficult to put my finger on. I suppose it boils down to this: where has the sense of personal responsibility gone? The principle of losing weight is very simple: you weigh yourself once a week, you keep cutting down your calorie intake until it’s below the level of your calorie requirements, and at that point your body starts burning your excess fat and you lose weight. That’s it really. I’ve done it myself, it’s not all that difficult, and it works 100% of the time. Eat less and you lose weight. Look at the photos of the liberation of the Nazi concentration camps: you don’t see any fat people.

So why is it my job, as a physician, to do for people what they won’t do for themselves: curb their appetites? It seems to be part of the trend towards hyper-professionalization in modern society. Low self esteem? The psychologist will fix it. Want entertainment? Don’t bother learning to play a musical instrument, just download some professional entertainment from the cable TV or internet. Car or household appliance broken down? Have a repairman fix it or buy a new one. Worried about the economy? The economists will take care of it. Too fat? The doctor will fix it. But for Heaven’s sake, don’t try to fix these things for yourself. Let the professionals do it for you.